The number of total elbow arthroplasty (TEA) procedures being performed in the United States continues to increase, especially with improving outcomes and expanding indications. Unlike lower extremity arthroplasty, there is a noticeable lack of literature regarding the management of periprosthetic infection and/or fracture about TEA. Recommended strategies to treat periprosthetic infection have included irrigation and debridement (I&D), resection arthroplasty, single and two-stage revision, arthrodesis, and/or amputation. However, most recommended strategies are not supported by high levels of evidence and thus, a lack of a consensus treatment algorithm remains.
Acute infections can be treated successfully with aggressive, early I&D with long-term intravenous (IV) antibiotics. Yamaguchi et al. recommended identification of the causative organism, as retention of implants seeded with S. epidermidis had a high risk of failure with I&D and IV antibiotics alone. A more recent study by Spormann et al., however, reported contrasting results noting 100% acute eradication, however, all of their patients were identified and treated less than three weeks from their index procedure. For chronic infections, there leaves only a few options: single-stage or two-stage explant/replant, resection arthroplasty, or arthrodesis.
Arthrodesis, considered a salvage procedure in almost any setting, is the least desired and the least successful in the setting of TEA infection. Arthrodesis in general severely debilitates the upper extremity being in a fixed position, but in the setting of TEA infection can yield poor results. Otto et al. in a recent case series reported inability to achieve any bony union for failed TEA secondary to deep infection, leaving all their patients with a resection arthroplasty. The authors concluded that even arthrodesis should not be considered an option in the setting of TEA infection.
Unlike the data available for periprosthetic fracture and infection in THA and TKA, the literature to devise an accepted algorithm for periprosthetic fracture and infection for TEA is unavailable. Instead, most recommendations come from level IV studies from the higher volume TEA surgeons, reporting their preferred methods and outcomes in treating periprosthetic infection.